Abstract

Objective: Electronic medical records seldom integrate performance indicators into daily operations. Assessing quality indicators traditionally
requires resource intensive chart reviews of small samples. We sought to use an electronic medical record to assess use of
β-adrenergic antagonist medications (β-blockers) following myocardial infarction, to compare a standardized manual assessment
with assessment using electronic medical records, and to discuss potential for future integration of performance indicators
into electronic records.

Design: Cross-sectional data analysis.

Setting: An urban academic medical center.

Participants: US Medicare beneficiaries 65 years of age or older, admitted to hospital with myocardial infarction between 1995 and 1999.

Measurements and main results: Manual chart review was compared with a computer driven assessment of electronic records. Administration of β-blockers and
cases excluded from use of β-blockers were measured, based on Medicare criteria. Among 4490 older adults, 391 (4%) of 9018
hospital admissions contained codes for myocardial infarction. In 323 (83%) of the 391 hospital admissions, criteria for excluding
β-blockers were met; 235 (60%) were excluded due to heart failure. Of 68 hospital admissions for myocardial infarction that
did not meet exclusion criteria, physicians prescribed β-blockers in 49 (72%) on admission and 42 (62%) at discharge. Compared
with manual chart review, electronic review had a sensitivity of 83–100% and led to fewer false negative findings.

Conclusions: An electronic medical records system can be used instead of chart review to measure use of β-blockers after myocardial infarction.
This should lead to integration of real time automated performance measurement into electronic medical records.

Footnotes

This work has been supported by Regenstrief Institute Inc, Health Care Excel Inc, and Centers for Medicare and Medicaid Services.
Dr Weiner is supported by grant number 5K23AG020088-02 from the National Institute on Aging (US). Dr Callahan is supported
by NIA grant number AG 00868.

The authors have no conflicts of interest in this work.

The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct
result of the Health Care Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services which has
encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required
no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging
with issues presented are welcomed.